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European Journal of General Medicine, Vol. 2, No. 3, 2005, pp. 120-122 A GIANT CERVICAL OSTEOCHONDROMA Nejmi Kıymaz1, Ali Doğan2, Nebi Yılmaz1, Çiğdem Mumcu1 Yüzüncü Yıl University, Faculty of Medicine,
Department of Neurosurgery1 and Orthopedic Surgery2 Van,
Turkey Code Number: gm05025 A giant solitary osteochondroma in 17-year-old-boy was reported. Osteocondromas usually involves the long bones, scapulae, pelvic bones and seldom occurs in the axial skeleton. A 17-year-old boy presented with a swelling at the rear of the neck and an advanced degree of limitation in the movements of his neck. A hard mass sized approximately 7x8 cm was revealed in this region. Cervical x-ray and CT revealed the mass involving the sixth cervical vertebrae. Giant cervical osteochondroma operated and the mass was successfully excised. Osteochondromas that consists the largest portion of benign bone tumors at the spine is seldom. Therefore we are introducing a osteochondroma case located at the lower cervical region where an advance degree of limitation in neck movements that displays no any neurological symptoms and that reaches a very wide mass in size, and which is assumed as unusual. Key words: Cervical spine, osteochondroma, surgical treatment INTRODUCTION The vertebral localization of the usual bone tumors known as osteochondromas are seldom (1,2). The ratio of osteochondromas in entire bone tumors is nearly 8.5% (3). Osteochondromas can be single, or multiple just like in Hereditary Multiple Exocytoses (HME). In this report we presented a giant osteochondroma located at the lower cervical region. CASE The examination of a 17-year-old-boy male patient that was referred to our neurosurgery clinic due to a swelling at the rear of the neck and an advanced degree of limitation in the movements of his neck revealed a hard, palpable mass at the dorsal lower cervical region, sensitive to fixed touches and with a dimension approximately 7x8 cm. The neurological examination of the patient was normal, however the movements of the neck was somehow limited to all directions. Cervical x-ray and cervical computerized tomograms (CT) determined a mass involving the sixth cervical vertebrae (Figure 1 and 2). Osteochondroma was diagnosed according to radiological findings. The patient was immediately operated and the mass was successfully excised. Histopathological examination also verified the diagnosis of osteochondroma. After surgery the patient's neck movements improved and turned to normal almost in all directions. During a year's follow-up no recurrence was detected. DISCUSSION As it is in our case, osteochondromas are more frequent in men and patients are generally under the age of 20 (2,4). Spinal osteochondromas rarely display symptoms. Cervical osteochondromas may compress the vertebral artery, subclavian artery and the common carotis artery (2,5,6). In our case there was no neurological symptom. However, there was an advances degree of limitation in neck movements due to the effect arising from the giant mass of the osteochondroma. After operation the mass was totally extracted and the neck movements of the patient began to improve. The main method that must be selected for diagnosis is x-ray and CT. The cartilaginous and bone components of the tumor can be determined by CT and its relationship with the peripheral region and neural tissues can be also determined (2,7,8). Magnetic resonance imaging is also helpful for the demonstration of spinal cord or nerve root compression (8) Pathologically, osteochondromas represent a dysplastic-hyperplastic disturbance of bone from progressive enchondral ossification (8,9). Our histologic diagnosis was osteocondroma. According to the localization of osteochondromas different standard surgical techniques can be applied. The purpose of surgical intervention should be to totally remove the tumor (1,10). In the present case the mass was extracted in total. Osteochondromas that consists the largest portion of bening bone tumors, seldomly affects the spine. Therefore we presented a osteochondroma locate in the lower cervical region with advanced limitation in neck movements and without any neurological symptom. This unusual presentation was considered clinically important so presented here. REFERENCES
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